Words to live by in the political world: Don’t ask for something, or you actually might get it.
If smart, the Legislature would make Gov. John Bel Edwards rue a couple of spending ideas he offered in his recently unveiled fiscal year 2017 budget.
Edwards intended to use some of his austerity scenarios to panic the public and to scare policymakers into steep tax increases — even as he refuses to meaningfully pare a state government that ranks well above the national average in per capita spending. Ironically, some of his ostensible “worst-case scenario” measures are actually excellent choices to cut unnecessary expenditures.
Budgeting about one-fifth of the present amount for the Taylor Opportunity Program for Students, or TOPS, would trigger a statute that raises the qualifying score on the ACT to 28 for students who want TOPS dollars for college. That would mean spending $240 million fewer dollars, and it’s the right thing to do.
The current standard for getting TOPS money, an ACT score of at least 20, is a point below the national average of all ACT takers. That positions TOPS as a middle-class-and-above entitlement, not something that rewards and inspires excellence. Making TOPS a true scholarship program by raising its standards will nudge students to work harder to achieve more in high school. Program dollars wasted on those who don’t earn college degrees will plunge.
Reducing Medicaid rate reimbursement reductions to “partner” providers — those nongovernmental entities that operate almost all of what Louisiana owns or designates as charity hospitals — isn’t the bad thing that Edwards administration officials suggest. A more stringent reimbursement policy allows the state to exit the charity model and avoid the extra, unneeded expense it entails. While all other states reimburse mostly nonstate-owned hospitals for care of the uninsured, by law, Louisiana’s charity system must provide free care to patients with family incomes at or below 200 percent of the federal poverty level and thereby handles over three-quarters of all uninsured care.
To entice partners, the state pays them a premium over what nonpartners receive for rendering the same services. Reducing this rate makes the partners skittish, for the extra money helps them cover greater uncompensated care costs. Almost all have said they would take a hard look at the proposed reductions with an eye toward opting out of the contracts, meaning the state would have to find an alternative way to deliver health care, according to its statutory duty, about three months after cancellation.
Yet why should the state pay more to prop up this uneconomical model? It simply should end the idea of preferential rates and, like other states, pay the same rate to all hospitals accepting Medicaid. (Almost all general hospitals do as part of fulfilling legal requirements.) The state should repeal the statute requiring it to deliver charity care and sell its facilities to the highest bidder. (Buyers will surface because of the demonstrable demand).
This policy choice becomes more compelling since Edwards unwisely accepted Medicaid expansion, as that means few uninsured will remain and the federal government allegedly will cut back drastically on funds available to states to finance indigent care. While each partner has a separate deal — making cost savings estimations imprecise — plotting this course likely would save Louisianans at least a couple of hundred million dollars a year.
When it convenes in regular session, the Legislature should take up Edwards on these items. Better to root out such inefficiencies than to take more of the people’s money to sustain them.
Jeff Sadow is an associate professor of political science at Louisiana State University Shreveport, where he teaches Louisiana government. He is author of a blog about Louisiana politics at www.between-lines.com, where links to information in this column may be found. When the Louisiana Legislature is in session, he writes about legislation in it at www.laleglog.com. Follow him on Twitter @jsadowadvocate. Write to him at firstname.lastname@example.org. His views do not necessarily express those of his employer.